title: A longitudinal study of anxiety, depression and distress as predictors of sexual and urinary quality of life in men with prostate cancer.
abstract: OBJECTIVE
  To evaluate the prevalence of depression, anxiety and distress among active surveillance (AS) and radical prostatectomy (RP) patients. To evaluate the impact of these symptoms at baseline on urinary and sexual quality of life at follow-up.
  
  
  METHODS
  Patients managed with AS or RP who completed validated questionnaires assessing levels of depression, anxiety, distress and urinary (UF) and sexual function (SF) and bother comprised the final analytic cohort. These measures were completed at baseline, within 1 year, and between 1 and 3 years from baseline. Mixed model repeated measures analysis was used to examine associations between mental health at baseline and sexual and urinary outcomes in a subset of RP patients with complete follow-up.
  
  
  RESULTS
  Among 679 men who comprised the study cohort, baseline prevalence of moderate or higher levels of depression or anxiety were low (<5%), while levels of mild depression or anxiety ranged from 3-16% over time. Baseline levels of elevated distress ranged from 8-20%. Among men who provided data at baseline and follow-up, there were no significant differences between AS and RP patients in the proportion of men with elevated levels of depression, anxiety, or distress. Among 177 men who underwent RP and had complete follow-up moderate or higher levels of depression or anxiety appeared to be associated with post-treatment SF and bother, while elevated levels of distress were associated with post-treatment UF.
  
  
  CONCLUSIONS
  Moderate or higher levels of depression or anxiety were low in men with localised prostate cancer but were associated with sexual outcomes, while elevated distress was associated with urinary outcomes. Greater attention should be paid to mental health symptoms among men with prostate cancer, as these symptoms may be associated with quality of life outcomes.
authors.affiliation: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94143-1695, USA. punnensp@urology.ucsf.edu
authors.forename: Sanoj
authors.initials: S
authors.lastname: Punnen
authors.forename: Janet E
authors.initials: JE
authors.lastname: Cowan
authors.forename: Laura B
authors.initials: LB
authors.lastname: Dunn
authors.forename: Dianne M
authors.initials: DM
authors.lastname: Shumay
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
mesh_terms: D001007:Anxiety / Q000453:epidemiology / Q000209:etiology*; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011788:Quality of Life; D019529:Sexuality; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*; D014554:Urination; D057832:Watchful Waiting